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New brain treatments: proceed with care

Posted on 01/07/2013

New technologies that can help people with serious disorders affecting the brain are needed, but must be used in ways that put the care and safety of patients first, says a report by the Nuffield Council on Bioethics.

Co-authored by Professor Jack Price (Department of Neuroscience at the Institute of Psychiatry at King's), Professor Ilina Singh and Professor Nikolas Rose from King’s College London, the report looks at ethical issues raised by technologies that ‘intervene’ in the brain, such as neural stem cell therapies, deep brain stimulation, transcranial brain stimulation and brain-computer interfaces.

Such technologies offer the potential to help people with severe conditions, such as Parkinson’s disease, Alzheimer’s disease, depression and stroke, for whom other treatment options have not been effective. However, there is not yet enough evidence about how effectively these technologies work and there are concerns over possible unintended consequences of their use and that premature speculation about their potential might raise false hopes amongst patients.

The report argues that smarter regulation is needed that encourages innovation in this area whilst recognising the complexity of the brain and prioritising the delivery of safe and effective treatments for patients in need. Amongst a number of recommendations, the Council suggests that better methods are needed for collecting doctors’ experiences of using these neurotechnologies, and that counselling should be provided for patients considering treatments that require surgery.

Professor Singh, from the Department of Social Science, Health & Medicine and the Institute of Psychiatry at King's, said: ‘Given that these treatments offer no guarantees, that there are real risks, and that people using them could be investing a great deal of hope in them, we feel strongly that counselling should be offered to patients who are considering treatment using invasive neurotechnologies, as these are most likely to present a complex mix of benefits and side effects.’

Some small studies of stimulating the brain with external devices have claimed to show small improvements in participants’ performance in exercises that test memory or language. It is also possible to buy gaming devices that claim to use brain signals to control game movement, by using a brain-computer interface (BCI) headset.

Professor Singh said: ‘It is unclear how, if at all, these supposed ‘enhancement’ effects seen in very small studies would translate into practical benefits in the real world, and we are concerned about false or misleading claims about what these might offer.’

Professor Tom Baldwin, Chair of the Nuffield Council’s enquiry, said: ‘Increasing numbers of people suffer from brain disorders, such as stroke, Alzheimer's, and Parkinson's, and there is a great need for new and effective treatments. But the brain is so important, and our understanding of it is still limited, so we must proceed with great care. We need to harness the benefits and minimise the possible harms raised by novel neurotechnologies. And to do that we need regulation that protects people from unnecessary harm and informs them of risks, but does not stifle innovative approaches to treating severe brain disorders.’

The new report sets out an ethical framework and recommendations to guide the practices of those involved in the development, regulation, provision and communication of novel neurotechnologies.

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